INTRODUCTION: Endometriosis can be defined as the occurrence of endometrial tissue ( glands and stroma) outside their typical intrauterine site. These ectopic endometrial implants are usually located on the pelvic organs and walls, but can occur nearly anywhere in the body. Clinical manifestations of such condition could range from totally asymptomatic to severely debilitating symptoms depending on the site and extent of the ectopic endometrial implants. This is a case report of a 33 year old woman with diaphragmatic endometriosis that was managed by laparoscopic excision.

CASE PRESENTATION: A 33 year old Nulliparous patient, with known Stage IV Endometriosis, represented with new symptoms of cyclical right sided shoulder and neck pain and dyschezia.  Investigation with MRI confirmed the presence of diaphragmatic endometriosis and a rectal nodule.  After careful counselling the patient decided to proceed with laparoscopic excision.  Pre-operative work-up included consultation with Cardiothoracic Surgery, who advised on management of any potential complications likely to be encountered intra-operatively. 

COMMENTS: Physicians should have a clear preoperative plan regarding the possible complications they might face as they operate in such cases.  Moreover, they should anticipate several intraoperative issues such as the patient positioning, location of port sites insertion, how to reach the lesions and the possible approach of excision of the diaphragmatic endometrial implants. These points will be discussed in details in our report as long with video footage of the excisional surgery.